Hypophosphatemia characterizes a deficiency of phosphate in the blood. It is very rare in industrialized countries and never occurs in healthy individuals with a balanced diet. Hypophosphatemia almost always occurs as a result of severe disease or malnutrition.
What is hypophosphatemia?
Hypophosphatemia is a condition in which the phosphate concentration in the blood has fallen below 0.8 millimoles per liter. As a result, mineral metabolism is impaired and energy supply to cells is reduced. Under normal circumstances, such a drastic decrease in phosphate concentration is not possible. The reasons almost always lie in severe diseases or deficiencies as well as malnutrition. Hypophosphatemia often develops as an additional symptom of an underlying disease. In the case of malnutrition, it is one of several sequelae. Hypophosphatemia is very rare in the general population. Healthy individuals never suffer from phosphate deficiency. According to previous experience, it occurs in about three percent of hospital patients, up to 30 percent of alcoholics, or up to 20 percent of chronic obstructive pulmonary disease patients. In addition, hypophosphatemia can occur in up to 80 percent of people with blood poisoning or severe injuries.
Causes
Causes of hypophosphatemia include malnutrition, alcoholism, artificial nutrition without added phosphate, vitamin D deficiency, chronic obstructive pulmonary disease, or acid-binding drugs (antacids). Since the body has a high buffering capacity for phosphates, phosphate deficiency is difficult to achieve. With a reduced intake of phosphates, the bones serve as a source of phosphates. In the process, they are degraded to a greater extent, so that osteoporosis can occur. In industrialized countries, malnutrition of the body is mainly caused by anorexia nervosa (anorexia). In addition to other nutrients, phosphates are also lacking here. Diseases associated with malabsorption of nutrients in the intestine can also lead to an undersupply of phosphates. These include such diseases as celiac disease or Krohn’s disease. Since phosphates form a low PH, acid-binding drugs simultaneously bind phosphates, which are then lost to the body. In the context of chronic obstructive pulmonary disease, there is increased exhalation of carbonic acid (carbon dioxide). The resulting increase in basicity in turn binds phosphates, so that this disease can also lead to phosphate deficiency. In alcoholism, the body is no longer adequately supplied with nutrients and phosphates. Increased loss of phosphates can also result in hypophosphatemia. For example, kidney disease or urine-promoting medications also increase flushing of phosphates from the body. Vitamin D deficiency or increased production of parathyroid hormone by the parathyroid gland also causes loss of phosphates.
Symptoms, complaints, and signs
Hypophosphatemia decreases energy production in the body’s cells. Phosphates are necessary for the formation of ATP, an important energy store. If this can no longer be produced in sufficient concentration, energy production also decreases. This lack of energy leads to fatigue, weakness and heart failure. Weight loss, nausea and vomiting also occur. Cardiac arrhythmias and respiratory problems are also frequently observed. For a long time, phosphate deficiency can be without symptoms. In mild cases, the phosphate mobilized from the bone is sufficient to keep its concentration in the blood constant. Only in the case of a greater phosphate deficiency do the typical symptoms appear. In the long term, bones can become brittle due to increased bone resorption. Affected children suffer from bone deformities and short stature. This condition often occurs with vitamin D deficiency and is known as rickets. Artificial feeding in the context of anorexia nervosa can lead to the so-called refeeding syndrome, which is often life-threatening. In this case, the energy requirement of the body cells and, at the same time, the phosphate requirement increase sharply. The preceding insufficient phosphate supply leads to a dangerous hypophosphatemia and disturbance of the electrolyte balance with cardiac arrhythmia, edema, tremors and even heart failure.When phosphate levels fall below 0.3 mmol/l, hemolysis and muscle cell destruction occur.
Diagnosis and course of the disease
Hypophosphatemia can be confirmed by blood analysis for phosphates if suspected. Typical symptoms may corroborate the suspected diagnosis of phosphate deficiency as part of the patient’s medical history. Phosphate levels should also be determined, especially in the context of malnutrition, malabsorption diseases of the intestine, COPD, alcoholism, or renal disease.
Complications
In most cases, hypophosphatemia occurs when there is malnutrition or the patient is severely ill. Consequently, the underlying disease must always be treated. Even at this stage, various complications may occur. However, the lack of phosphate also has a negative effect on the patient’s health. This results in a general feeling of illness and severe fatigue. The patient also suffers from heart and respiratory problems. Sudden cardiac death or gasping for breath may also occur. The patient’s life expectancy is greatly reduced by untreated hypophosphatemia. If hypophosphatemia already occurs in children, it can lead to short stature or other disorders of the patient’s physical and mental development. Hereditary failure may also occur. Complications can occur if the phosphate is overdosed during treatment, in which case the kidneys in particular can be damaged. Patients who change their diet during treatment often experience fewer complications. The symptoms then disappear again within a few days.
When should you see a doctor?
When fatigue, weakness, and other typical symptoms of hypophosphatemia are noticed, medical advice is needed. Individuals who suddenly lose weight or suffer recurrent nausea and vomiting without an identifiable cause should also talk to their primary care physician quickly. In the event of serious complications such as cardiac arrhythmia or circulatory problems, it is best to consult a doctor on the same day. This is particularly necessary if the feeling of illness rapidly increases in intensity or there is a risk of falls. In the event of serious circulatory problems, those affected should call the emergency doctor. Accompanying first aid measures must be provided. The emergency services should also be alerted immediately in the event of heart failure or circulatory collapse. Further treatment is provided by the family doctor or an internist. People suffering from malnutrition, alcohol addiction and other diseases that may cause phosphate deficiency are particularly susceptible to the development of hypophosphatemia and should definitely go to the appropriate doctor with symptoms mentioned.
Treatment and therapy
Treatment of hypophosphatemia depends on the underlying disease or disorder. In cases of mild phosphate deficiency, it is sufficient to change the diet somewhat to more phosphate-rich foods. This is usually accomplished by increasing consumption of milk and dairy products. In many cases, the phosphate deficiency is already compensated in this way. Sodium or potassium phosphate may also be administered for greater deficiencies of phosphate. Intravenous phosphate solutions are often administered to intensive care patients. However, care must be taken not to overdose phosphate. In case of overdose, renal failure, hypocalcemia, falling blood pressure and cardiac problems will occur. However, it is very important to treat the underlying disease or end the deficiency state by a balanced diet.
Prevention
Hypophosphatemia can be prevented by a healthy and balanced diet. However, it should be noted that phosphate deficiency is very difficult to be caused by a wrong lifestyle. The lifestyle must already be so extremely deviant that it is already considered a disease, as in the case of anorexia nervosa or alcoholism. Here it is important to work through deeper-lying problems psychotherapeutically. Other causative diseases also require intensive treatment.
Aftercare
Depending on the severity of hypophosphatemia, there is follow-up treatment with medication or dietary changes. Mild phosphate deficiency can be prevented by ingesting phosphate-rich foods, such as dairy products.In case of a larger deficit, dietary supplements with sodium phosphate or potassium phosphate are available. By changing the diet, it is quite easy to avoid the previous problems. Those affected can obtain the relevant advice from their doctor, pharmacist or professional nutritionist. Care must be taken to ensure that patients do not take in too much phosphate. In general, it helps to focus on a balanced diet during follow-up care. Good self-monitoring is useful in any case. In this context, those affected should inform themselves comprehensively about the signs and causes of phosphate deficiency. Sometimes there are psychological triggers for the disease that are more difficult to recognize. Especially in the phase after initial treatment, such deeper-lying reasons may surface. Psychotherapy may be advisable to successfully combat the physical symptoms through comprehensive aftercare. The appropriate reappraisal has a positive effect on the body image and on the overall quality of life of those affected.
What you can do yourself
The options for self-help are relatively limited for the symptoms of hypophosphatemia. However, if the condition occurs due to malnutrition, the diet must be changed. To eliminate the lack of phosphate, fish and nuts are particularly suitable. In general, as soon as those affected are properly nourished, a rapid improvement occurs and the deficiency can be eliminated. Friends can also help in the preparation of a diet plan, although in serious cases the use of a nutritionist is advisable. Likewise, the affected person can take dietary supplements from the pharmacy to counteract the deficiency. The consumption of dairy products also has a very positive effect on the course of the disease. Furthermore, the affected person should note that the amount of phosphate should not be exceeded. This is especially important when taking supplements. In case of doubt, a doctor should always be consulted. Since hypophosphatemia leads to heart problems and muscle weakness, the affected person should take it easy and not engage in sports or strenuous activities. In cases of severe eating disorders, discussions with parents or friends often help. However, discussions with other sufferers may also prove useful.